Anesthesiology Focus for Operating Room Efficiency

When anesthesiologists and physicians at St. Luke's Hospital began to look at OR inefficiencies, they didn't have to look far: Surgeons were competing with each other for time and space in the OR. And they experienced a shortage of available anesthesiologists.

As St. Luke's and another hospital tapped into an anesthesiology group, they found that they sometimes had to "take a number" to get a doctor. The anesthesiologists were sent from hospital to hospital as needs arose. Sometimes, one surgeon's need conflicted with another's. Sometimes, there were too many physicians and anesthesiologists available for surgery; at other times, too few. St. Luke's officials knew they were in the midst of a money-losing proposition. The problem, as they saw it, was limited resources and an inefficient scheduling system.

The various demands, particularly on the anesthesiology group, "shot holes in the schedule for the operating rooms at each institution," Herring says. "There was a huge variability for surgical loads at each place. You would have peak times that were difficult to staff and cause the hospital to spend overtime, yet there were low periods, too. Surgeons would compete with each other for personnel and equipment, and there was a need for anesthesiologists as well. For the hospital, it was a costly and very significant dissatisfaction. The anesthesiologists were trying to satisfy the surgeons' needs, not realizing it was creating a disadvantageous position for the hospital. The hospital made it apparent this was a problem and needed the resources to be more stable."

Block time was the solution. With this technique, it is important to coordinate all the surgical equipment needed for a specific surgery but also to involve anesthesiologists. By establishing the block times, office space and surgery space is coordinated for the different physicians, nurses, and anesthesiologists involved in the process, he says.

By utilizing the block schedule, the hospital has reduced conflicts in using the OR and avoided delays in the start of surgery, says Herring. Over the past two years, available block hours—reserved time for specific surgeons and procedures—have increased from 300 to 1,000 per month. The hospital estimates that it has improved overall utilization of the OR, without empty spaces, from 50% to 77% over that time, Herring adds. The hospital also anticipates it can reduce staff attrition by improving the OR efficiency, with an ultimate savings of $2 million in direct cost and the potential for $2 million of savings in indirect costs, Herring adds.

The New Milford (Conn.) Hospital also has used block scheduling to avoid delays and eliminate competing schedules, says Edward A. Zane, MD, chief of the department of anesthesiology and medical director for the OR. Surgeons are held accountable for their schedules and may lose their scheduled surgeries if there are conflicts. But if they are efficient in their scheduling, are high utilizers, and have a high volume of low-acuity cases, they are allotted additional block time, Zane says.

On each scheduled shift, anesthesiologists play a key role, Zane adds. For surgeons, it's important that each day they book their schedules early and coordinate with anesthesiologists. "We work with the surgeons and assign an anesthesiologist to a room each day," Zane says.

Brian D Gregory (12/27/2012 at 2:41 PM)
You might like to take a look at www.ortimes.org. It's about OR productivity with lots of graphs, numbers, and logic.

Bryan Warren (12/27/2012 at 2:06 PM)
Great article-hitting all the key success factors but one: Alignment should also talk about alignment of the hospital's goals with the financial arrangement with the Anesthesia group(s). If they are independent, their incentives may not be such that they are willing/interested in changing their practices. I've even seen employed An. groups or those under contracts financially incentivized in such a manner that goals weren't aligned.